Patients with severe character disorders are usually viewed as unsuitable candidates for brief forms of psychodynamic psychotherapy. Frequently, these patients drop out of therapy when it is offered, or they fail to make significant gains. Consequently, they become "psychotherapy shoppers", going from clinic to clinic continuously troubled and increasingly demoralized by their experiences with mental health professionals. The proposed study intends to demonstrate that greater therapeutic success with a group of severely disordered patients can be obtained when the model of treatment is designed to respond to the distinctive character structure and antecedant developmental deviations typically evident in these difficult-to-treat patients. Brief Individual-Group Psychotherapy (BIGP) consists of an integrated program of 16 sessions of psychoanalytically oriented psychotherapy followed by 10 sessions of psychoanalytically oriented group psychotherapy. The objectives of the proposed study are as follows: 1) To test a method to reliably select a cohort of patients with severe character pathology; 2) To assess the effectiveness of a brief integrated, individual-group model of psychotherapy for severe character disorders; 3) To examine several process variables (therapist interventions, patient response and therapeutic alliance) for their power to predict psychotherapeutic change; 4) To develop a comprehensive therapy manual which will be used in the future to instruct therapists, during their post graduate training, to recognize and treat patients who are severely disturbed. Patients selected according to specific criteria of character pathology will be treated by experienced psychoanalytically trained psychotherapists. Outcome will be rated from three perspectives; the patients, the therapists, and clinical judges. The patients treated with brief group-individual psychotherapy will be comared with a comparable reference group of patients who receive "treatment as usual". Several therapeutic process variables will be rated and examined for their associations with outcome. All study patients will be seen in follow-up at termination, at six months and one year following termination. This study will make a contribution toward the development of more effective methods for treating a group of patients who place considerable demands on the mental health system. It is hoped that the results of the project will lead to better utilization of psychiatric services and a commensurate improvement in cost effectiveness.